Navigating the Intensity of PACE Program Audits in 2023

Laura Ferrara, Chief Strategy Officer at Intus Care

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In the last blog post, we looked at some of the insights Intus Care has gleaned from working hand-in-hand with over half-dozen PACE programs going through a CMS audit over the last year. The audits have had greater scrutiny than years prior on provision of services and care coordination, particularly to ensure they weren’t just completed but were also effective for participants. Today, we are going to dig into why the audits have been more intense and ways PACE programs can use this process to improve operations long after the audit is over.

One reason the audits have seemed more intense is that the audit teams are larger which allows them to be more detailed and reflective on the provision of services and their effectiveness. Programs should be prepared for detailed scrutiny with requests for additional documentation with tighter turnaround timelines than in years past. In some cases, documentation is requested and required back by the next business day, so programs had to respond quickly which is easier to do when the data and documentation are available readily. These requests encompass a range of documents, including external reports and documentation within the medical record, emphasizing the need for thorough record-keeping.

For programs that have recently gone through the rigorous audit process, we recommend using the experience as a comprehensive review of their operations, outcomes, and compliance with audit focus areas. For programs that did not go through the process this year, there is still a lot that can be gained and adjusted for your future success. A colleague once told me this and it stuck with me: “The smart person learns by their own mistakes, and a genius learns by the mistakes of others.” Reflect on the audit process now to look critically at your program’s operations. Look to identify areas for improvement in participant care and documentation to be ahead of the game.

In the next blog, I will explore planned regulatory changes for 2024 that can further enhance your program’s planning for the future. By proactively embracing the evolving landscape of PACE program audits, programs can position themselves for success, ensure participant well-being, and stay ahead of regulatory changes. In the meantime, contact Intus Care about mock audits through our website contact page:

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